Provider Demographics
NPI:1750160727
Name:HALL, THOMAS L JR (MSN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:HALL
Suffix:JR
Gender:
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4464 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48412-7700
Mailing Address - Country:US
Mailing Address - Phone:810-656-9996
Mailing Address - Fax:
Practice Address - Street 1:4464 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:MI
Practice Address - Zip Code:48412-7700
Practice Address - Country:US
Practice Address - Phone:810-656-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300502207PE0004X, 207Q00000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner